免疫检查点抑制剂 (ICIs) 在肿瘤学领域具有革命性意义，但可能会导致免疫相关 (IR) 副作用，例如垂体炎。抗 PD-(L)1、抗 CTLA-4 或抗 CLTA-4/PD-1 治疗可能会诱发垂体炎，但人们对临床表现的差异或不同治疗的需要知之甚少。我们分析了抗PD-(L)1、抗CTLA-4和抗CTLA-4/PD-1引起的垂体炎的差异。对67例患者进行回顾性分析(27例抗PD-(L)1，6例抗PD-(L)1) -CLTA-4 和 34 抗 CTLA-4/PD-1 诱导的垂体炎）。抗 PD(L)-1）治疗后，开始 ICI 和 IR 垂体炎之间的中位时间更长（22 周与 11 周和 14 周相比）分别在抗 CTLA-4 和抗 CTLA-4/PD-1 治疗后）。大多数患者（>90%）出现非典型症状，如疲劳、恶心和肌肉症状。与抗 PD-(L)1 诱导的垂体炎相比，头痛、TSH 或 LH/FSH 缺乏在抗 CTLA-4 和抗 CLTA-4/PD-1 中更常见（83% 和 58% vs 8%、67%）分别为 41% 和 11%，以及 83% 和 48% 和 7%）。 MRI 上的垂体异常（垂体炎或继发性空蝶鞍综合征）仅见于接受抗 CTLA-4 或抗 CTLA-4/PD-1 治疗的患者。平均 14 天和 104 天后，TSH、LH/FSH 和 ACTH 缺乏症的恢复率分别为 92%、70% 和 0%，并且在接受或未接受高剂量治疗的患者之间没有差异IR 垂体炎的临床表现因 ICI 的类型而异。 MRI 异常仅见于抗 CTLA-4 或抗 CTLA-4/PD-1 诱导的垂体炎。无论皮质类固醇剂量如何，LH/FSH 和 TSH 缺乏都会导致内分泌恢复，但 ACTH 缺乏则不会。版权所有 © 2024 van der Leij、Suijkerbuijk、van den Broek、Valk、Dankbaar 和 van Santen。

Immune checkpoint inhibitors (ICIs) are revolutionary in oncology but may cause immune-related (IR) side effects, such as hypophysitis. Treatment with anti-PD-(L)1, anti-CTLA-4 or anti-CLTA-4/PD-1 may induce hypophysitis, but little is known about the differences in clinical presentation or need for different treatment. We analyzed the differences of anti-PD-(L)1, anti-CTLA-4 and anti-CTLA-4/PD-1 induced hypophysitis.retrospective analysis of 67 patients (27 anti-PD-(L)1, 6 anti-CLTA-4 and 34 anti-CTLA-4/PD-1 induced hypophysitis).The median time between starting ICIs and IR-hypophysitis was longer after anti-PD(L)-1) therapy (22 weeks versus 11 and 14 weeks after anti-CTLA-4 and anti-CTLA-4/PD-1 therapy, respectively). The majority of patients (>90%), presented with atypical complaints such as fatigue, nausea, and muscle complaints. Headache, TSH or LH/FSH deficiency were more common in anti-CTLA-4 and anti-CLTA-4/PD-1 versus anti-PD-(L)1 induced hypophysitis (83% and 58% versus 8%, 67% and 41% versus 11%, and 83% and 48% versus 7%, respectively). Pituitary abnormalities on MRI (hypophysitis or secondary empty sella syndrome) were only seen in patients receiving anti-CTLA-4 or anti-CTLA-4/PD-1 therapy. Recovery from TSH, LH/FSH and ACTH deficiency was described in 92%, 70% and 0% of patients after a mean period of 14 and 104 days, respectively, and did not differ between patients who did or did not receive high-dose steroids.The clinical presentation of IR-hypophysitis varies depending on the type of ICIs. MRI abnormalities were only seen in anti-CTLA-4 or anti-CTLA-4/PD-1 induced hypophysitis. Endocrine recovery is seen for LH/FSH and TSH deficiency but not for ACTH deficiency, irrespective of the corticosteroid dose.Copyright © 2024 van der Leij, Suijkerbuijk, van den Broek, Valk, Dankbaar and van Santen.